Pharmacological Measures Overall

Pharmacological interventions are the standard treatment for SCI pain. The limited effectiveness of non-pharmacological treatments has contributed to increasing use of pharmacological interventions to deal with what is often very severe and disabling pain.

Discussion

Widerström-Noga and Turk (2003), not unexpectedly, found that SCI patients with more severe pain, in more locations, those with allodynia or hyperalgesia, and those in whom the pain was more likely to interfere with activities were more likely to use pain medications.

Trials of simple non-narcotic analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or non-narcotic “muscle relaxants” are common clinical practice in SCI pain. Unfortunately, these medications are often ineffective in complete SCI neuropathic pain relief and have potential risks such as gastric ulceration with prolonged use.

For neuropathic or “central” pain seen following SCI, psychotropic drugs such as antidepressants and anticonvulsants are reportedly the most effective (Donovan et al. 1982). Despite increasing popularity, few drugs (with the exception of Gabapentin and pregabalin) have regulatory approval for use in neuropathic pain and selection for individual patients is largely based on anecdotal evidence, of off-labelled use.